The present invention pertains to the field of surgery and specifically to surgical suturing devices for and methods of aortic dissection including anastomosing a graft onto blood vessels, such as the aorta. However, the invention is equally applicable to joining any generally tubular vessels or organs to each other in end-to-end relationship.
One conventional way of connecting blood vessels is by the manual placement of sutures which is time consuming and demands highly specialized skills. It usually takes about ten to twenty minutes to complete each anastomosis. For many operative interventions, a number of such connections are required, and tissues which are deprived of blood supply during any particular procedure suffer from ischemia which can produce degenerative and necrotic changes. Bleeding also occurs frequently from such manually performed anastomoses which prolongs and complicates the procedures. Other disadvantages of manual suturing are apparent and more frequently automatic staplers are now used for suturing, particularly for suturing hollow organs in gastrointestinal surgery. U.S. Pat. No. 5,720,755 (Dakov) discloses a stapler which ejects staples axially relative to the walls of flanged or cuffed blood vessels, especially arteries, though such is said to be a difficult and time consuming procedure, as compared to that of gastrointestinal organs. One major difficulty involving cardiovascular surgery utilizing staples for suturing is the limited space within the operative area which makes conventional methods unsuitable for use with blood vessels. The latter patent makes reference to Pat. No. 5,188,638 (Tzakis) as an example of suturing vessel walls which must be cuffed in order to perform the procedure. A major disadvantage of the stapling device of the latter patent is the utilization of an annular anvil which is of an elliptical or ellipsoid configuration formed by two split halves which are lightly glued together. The annular anvil is not only difficult to position incident to the performance of the anastomosis procedure, but at the completion thereof the anvil must be essentially xe2x80x9cbrokenxe2x80x9d into two separate pieces to effect the removal of the two anvil parts from the cuffed organ or vessel which is also necessarily tied down to the annular anvil in and against an annular outwardly opening groove thereof, normally by conventional manually applied sutures. Thus, after the completion of the stapling operation, the sutures must also be removed and the annular anvil must thereafter be split and carefully removed which involves extremely delicate and facile efforts in a relatively small operative area.
The present invention solves all of the aforementioned problems through the utilization of a novel suturing device, and particularly a novel tubular or annular anvil sleeve defined by at least two sleeve portions which are pivotally connected to each other for pivotal movement from a first closed tubular stapling position to a second open removal position. The pivoting motion is about a pivot axis which is substantially parallel to but radially outwardly offset from an axis defined by the tubular anvil sleeve in its closed position. Due to the latter construction, the anvil sleeve can be axially slid from an internal telescopic position relative to the stapled blood vessel and/or graft while closed and thereafter can be pivoted to its open position for removal. The suture, glueing and xe2x80x9cbreakingxe2x80x9d of the tubular anvil of U.S. Pat. No. 5,188,638 is thus entirely eliminated along with the disadvantages associated therewith.
With the above and other objects in view that will hereinafter appear, the nature of the invention will be more clearly understood by reference to the following detailed description, the appended claims and the several views illustrated in the accompanying drawings.